Lancet Study: Whole-body MRI scans are as accurate as standard imaging pathways for lung cancer staging

NIHR | July 2019 | Whole-body MRI scans are as accurate as standard imaging pathways for lung cancer staging

The latest Signal from the National Institute for Health Research (NIHR) highlights the findings of a study that reports using whole-body magnetic resonance imaging (MRI) in the initial investigation pathway is as good as standard pathways for detecting metastatic disease in adults with non-small-cell lung cancer. This NIHR-funded study also found that WB-MRI used for diagnosis and staging is quicker, cheaper and requires fewer other investigations than standard pathways.

Although patients reported that having whole-body MRI was a greater burden than standard imaging, they generally preferred whole-body MRI if it reduced staging times. In theory, it may also reduce radiation exposure, as most people would not need to have a positron-emission tomography CT scan.

Current NICE guidance recommends a sequence of investigations for staging – assessing the extent of cancer in order to plan appropriate treatment. MRI of different areas of the body is only recommended after other imaging investigations. This study suggests that whole-body MRI could have a role earlier in the pathway (Source: NIHR).

Read the full Signal from NIHR

Full reference:

Taylor, S. et al | 2019|  Diagnostic accuracy of whole-body MRI versus standard imaging pathways for metastatic disease in newly diagnosed non-small-cell lung cancer: the prospective Streamline L trial| The Lancet Respiratory Medicine|523-532 | https://doi.org/10.1016/S2213-2600(19)30090-6

Background

Whole-body magnetic resonance imaging (WB-MRI) could be an alternative to multi-modality staging of non-small-cell lung cancer (NSCLC), but its diagnostic accuracy, effect on staging times, number of tests needed, cost, and effect on treatment decisions are unknown. We aimed to prospectively compare the diagnostic accuracy and efficiency of WB-MRI-based staging pathways with standard pathways in NSCLC.

Methods

The Streamline L trial was a prospective, multicentre trial done in 16 hospitals in England. Eligible patients were 18 years or older, with newly diagnosed NSCLC that was potentially radically treatable on diagnostic chest CT (defined as stage IIIb or less). Exclusion criteria were severe systemic disease, pregnancy, contraindications to MRI, or histologies other than NSCLC. Patients underwent WB-MRI, the result of which was withheld until standard staging investigations were complete and the first treatment decision made. The multidisciplinary team recorded its treatment decision based on standard investigations, then on the WB-MRI staging pathway (WB-MRI plus additional tests generated), and finally on all tests. The primary outcome was difference in per-patient sensitivity for metastases between standard and WB-MRI staging pathways against a consensus reference standard at 12 months, in the per-protocol population. Secondary outcomes were difference in per-patient specificity for metastatic disease detection between standard and WB-MRI staging pathways, differences in treatment decisions, staging efficiency (time taken, test number, and costs) and per-organ sensitivity and specificity for metastases and per-patient agreement for local T and N stage. This trial is registered with the International Standard Randomised Controlled Trial registry, number ISRCTN50436483, and is complete.

Findings Between Feb 26, 2013, and Sept 5, 2016, 976 patients were screened for eligibility. 353 patients were recruited, 187 of whom completed the trial; 52 (28%) had metastasis at baseline. Pathway sensitivity was 50% for WB-MRI and 54% (41–67) for standard pathways, a difference of 4%. No adverse events related to imaging were reported. Specificity did not differ between WB-MRI (93% [88–96]) and standard pathways. Agreement with the multidisciplinary team’s final treatment decision was 98% for WB-MRI and 99% for the standard pathway. Time to complete staging was shorter for WB-MRI (13 days [12–14]) than for the standard pathway (19 days [17–21]); a 6-day (4–8) difference. The number of tests required was similar WB-MRI (one [1–1]) and standard pathways (one [1–2]). Mean per-patient costs were £317 (273–361) for WBI-MRI and £620 (574–666) for standard pathways.

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NICE: Innovative treatment for gynaecological cancers approved for Cancer Drugs Fund

NICE |  July 2019 | Innovative treatment for gynaecological cancers approved for Cancer Drugs Fund

NICE has announced that it has approved Olaparib, a medicine that has previously been used at a later stage in the treatment of advanced ovarian cancer, has now been approved by NICE as a first-line maintenance treatment. 

Currently around 700 women with advanced ovarian cancer are expected to benefit from this new treatment option. As a maintenance therapy, it is used to prevent the cancer returning after primary treatment. It is taken as a tablet twice-a-day

Director of the NICE Centre for Health Technology Evaluation,Meindert Boysen “The availability of olaparib tablets as maintenance therapy is an important development in the management of BRCA mutation-positive advanced ovarian cancer. Olaparib is already used for ovarian cancer but is expected to have the greatest benefit when used early, and is considered to have the potential to cure the disease in some people if given before the first recurrence.

“We are pleased that the company has agreed a commercial arrangement for olaparib that will allow it to be made available immediately to people who currently have an unmet need for maintenance treatment.”

Read the full news story from NICE

Related:

Final appraisal document Olaparib for maintenance treatment of BRCA
mutation-positive advanced ovarian, fallopian tube or peritoneal cancer after response to first-line platinum-based chemotherapy

In the news:

BBC News Ovarian cancer drug olaparib ‘can delay disease in newly diagnosed’

The Independent  ‘Game- changing’ ovarian cancer drug receives NHS approval

 

Most-At-Risk Residents Of South Kirkby Reap The Benefits Of New Lung MOT​

West Yorkshire and Harrogate Cancer Alliance | July 2019 | Most-At-Risk Residents Of South Kirkby Reap The Benefits Of New Lung MOT​

Residents in South Kirby and Hemsworth between the age of 55 and 74 who smoke or used to smoke are being invited to be part of a targeted lung health check pilot programme led by the West Yorkshire and Harrogate Cancer Alliance, in partnership with Yorkshire Cancer Research.

This ‘Lung MOT’ involves patients receiving a half hour checkup where specially trained nurses at a GP Surgery assess their breathing and overall lung health, measure their height and weight; and may also conduct a breathing test to identify any problems that may need further attention. Patients are also given a six-year risk score calculation for developing lung cancer. Current smokers are then offered the opportunity to access the stop smoking service.

As part of this service a number of patients have also taken up the opportunity to access free advice and help to quit smoking which is being provided on site by specialist advisors. Evidence has shown that access to such support gives smokers the best possible chance of giving up (Source: West Yorkshire and Harrogate Cancer Alliance).

Read the full news story at West Yorkshire and Harrogate Cancer Alliance

 

 

New life-saving treatment and diagnosis technology

Diseases could be detected even before people experience symptoms, thanks to a pioneering new health-data programme as part of the government’s modern Industrial Strategy

Businesses and charities are expected to jointly invest up to £160 million, alongside a £79 million government investment, as part of the Accelerating Detection of Disease programme. The project will support research, early diagnosis, prevention and treatment for diseases including cancer, dementia and heart disease.

The pioneering initiative will recruit up to 5 million healthy people. Volunteered data from the individuals will help UK scientists and researchers invent new ways to detect and prevent the development of diseases.

Full story: UK to innovate new life-saving treatment and diagnosis technology | Department of Health & Social Care

Cancer Research UK funding tops half a billion pounds

Cancer Research UK raised £540m in fundraising income in the last financial year, an increase of 2 per cent over the previous year, in one of its most successful fundraising years so far.

This increase was in part thanks to more money raised from legacy donations, Race for Life and Stand Up To Cancer, which all raised more than the previous year.  And an additional £2m was raised via Facebook charitable giving, an innovative new fundraising platform that launched towards the end of the year.

Total income for the year was £672m, an increase of 6% on the previous year, which includes fundraising income as well as £125m income from charitable activities – the largest amount ever received, which will be reinvested in research.

Key achievements outlined in Cancer Research UK’s annual report and accounts,  include:

• Securing a strong commitment to early cancer diagnosis in the NHS Long Term Plan.
• Three new international Grand Challenge teams awarded £20m each over the next five years, to solve long-standing mysteries in cancer research
• Launching the Cancer Research UK City of London Centre, a £14m investment to create a world-leading cancer therapeutics research hub.
• Launching a new Brain Tumour Award funding scheme, to accelerate progress in research on brain tumours.

Full press release at Cancer Research UK

Breast cancer drugs option joins cancer drugs fund

A potentially life-extending drug combination for some people with advanced breast cancer will now be available under the cancer drugs fund (CDF) following approval by NICE and publication of draft guidance

The draft guidance recommends ribociclib (also called Kisqali and made by Novartis) used with fulvestrant as an option for people with hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, locally advanced or metastatic breast cancer who have had previous endocrine therapy.

The positive recommendation follows an improved patient access scheme by the company as part of a commercial arrangement.

Clinical trial evidence suggests that, compared with fulvestrant alone, ribociclib with fulvestrant increases the length of time before the disease progresses. However, it is not known whether ribociclib increases the length of time people live, because the final trial results are not available yet.

The committee recognised that ribociclib with fulvestrant has the potential to be cost-effective, and therefore recommended it for use on the CDF. This will allow more evidence to be collected to address the uncertainties around overall survival and cost-effectiveness.

Full dtail at NICE

Cancer Research: Skin cancer diagnoses rise by 45% in a decade

Cancer Research UK| July 2019 | Skin cancer rates rocket by 45% in 10 years 

Figures analysed by Cancer Research UK (CRUK) demonstrate that in the 10 years since 2004 skin cancer rates rose by  more than a third (35%) for women and by almost three-fifths (55%) for men.

The figures have been released to mark the launch of the charity’s Own Your Tone campaign which encourages people to embrace their natural skin tone and protect their skin from too much sun.

Image source: cancerresearchuk.org

Melanoma skin cancer is the fifth most common cancer in the UK and the second most common cancer in people aged 25-49, but almost 90% of melanoma cases could be prevented if people took better care of their skin in the sun both at home and abroad. Getting sunburnt, just once every two years, can triple the risk of melanoma skin cancer.

Karis Betts, health information manager at Cancer Research UK, said: “Sun safety is not just for when you’re going abroad, the sun can be strong enough to burn in the UK from the start of April to the end of September, so it’s important that people are protecting themselves properly both at home and further afield when the sun is strong. We want to encourage people to embrace their natural look and protect their skin from UV damage by seeking shade, covering up and regularly applying sunscreen with at least SPF 15 and 4 or 5 stars.” (Source: Cancer Research UK)

Read the full press release from Cancer Research UK 

In the news:

Independent Cheap flights blamed as skin cancer rates soar by 45 per cent in a decade

BBC News Skin cancer risk ‘not just from holiday sun’

Lung cancer (update)

NICE |  July 2019 | Lung cancer (update)

NICE’s Quality standard consultation is now open for comments 

The consultation will close on Friday 23 August 2019 at 5pm

Details available from NICE 

Meaningful increases in physical activity levels after cancer can be sustained for three months or more, finds Systematic Review

NIHR | July 2019 | Meaningful increases in physical activity levels after cancer can be sustained for three months or more

An NIHR-funded review is the first review of physical activity maintenance across cancer types. The review pooled 19 studies which measured the effect of interventions for physical activity on 5,792 adult cancer survivors. 

Interventions which were included in the review included supervised group exercise sessions, telephone coaching, education and encouragement to do home-based exercise. Providers included physiotherapists, counsellors and health coaches. Control groups were mostly given printed exercise leaflets.

Patients who received only printed materials also achieved modest increases in physical activity, suggesting low-intensity interventions may be sufficient in promoting small changes in behaviour for some motivated groups. By contrast, the results suggest that more intensive and costly interventions with support could be targeted at groups such as older people with physical limitations (Source: NIHR).

Full details from NIHR

Grimmett, C., et al | 2019| Systematic review and meta-analysis of maintenance of physical activity behaviour change in cancer survivors | International Journal of Behavioural Nutrition and Physical Activity| 16| 37 | https://doi.org/10.1186/s12966-019-0787-4

Abstract

Background

Physical activity can improve health and wellbeing after cancer and may reduce cancer recurrence and mortality. To achieve such long-term benefits cancer survivors must be habitually active. This review evaluates the effectiveness of interventions in supporting maintenance of physical activity behaviour change among adults diagnosed with cancer and explores which intervention components and contextual features are associated with effectiveness.

 

Methods

Relevant randomised controlled trials (RCTs) were identified by a search of Ovid Medline, Ovid Embase and PsychINFO. Trials including adults diagnosed with cancer, assessed an intervention targeting physical activity and reported physical activity behaviour at baseline and more than or equal to 3 months post-intervention were included. The behaviour change technique (BCT) taxonomy was used to identify intervention components and the Template for Intervention Description and Replication to capture contextual features. Random effect meta-analysis explored between and within group differences in physical activity behaviour. Standardised mean differences (SMD) describe effect size.

 

Results

Twenty seven RCTs were included, 19 were pooled in meta-analyses. Interventions were effective at changing long-term behaviour; SMD in moderate to vigorous physical activity (MVPA) between groups 0.25; 95% CI = 0.16–0.35. Within-group pre-post intervention analysis yielded a mean increase of 27.48 (95% CI = 11.48-43.49) mins/wk. of MVPA in control groups and 65.30 (95% CI = 45.59–85.01) mins/wk. of MVPA in intervention groups. Ineffective interventions tended to include older populations with existing physical limitations, had fewer contacts with participants, were less likely to include a supervised element or the BCTs of ‘action planning’, ‘graded tasks’ and ‘social support (unspecified)’. Included studies were biased towards inclusion of younger, female, well-educated and white populations who were already engaging in some physical activity.

 

Conclusions

Existing interventions are effective in achieving modest increases in physical activity at least 3 months post-intervention completion. Small improvements were also evident in control groups suggesting low-intensity interventions may be sufficient in promoting small changes in behaviour that last beyond intervention completion. However, study samples are not representative of typical cancer populations. Interventions should consider a stepped-care approach, providing more intensive support for older people with physical limitations and others less likely to engage in these interventions.

Link to full text article:

NIHR Signal Meaningful increases in physical activity levels after cancer can be sustained for three months or more

BMC Systematic review and meta-analysis of maintenance of physical activity behaviour change in cancer survivors

Emergency presentations of cancer: quarterly data

Estimated proportion of all malignant cancers where patients first presented as an emergency | Public Health England

The quarterly emergency presentations of cancer data has been updated by PHE’s National Cancer Registration and Analysis Service (NCRAS). This latest publication includes quarterly data for October 2018 to December 2018 (quarter 3 of financial year 2018 to 2019) and an update of the one year rolling average.

Data estimates are for all malignant cancers (excluding non-melanoma skin cancer) and are at CCG level, with England as a whole for comparison.

The proportion of emergency presentations for cancer is an indicator of patient outcomes.

Full detail at Public Health England